The nurse is caring for a client after a thoracentesis that drained 50 mL of clear fluid from the left lung. Which assessment finding should the nurse report to the healthcare provider immediately?
A.
Dullness bilaterally on percussion.
B.
Serosanguinous drainage from the chest tube.
C.
Diminished breath sounds in the left lower lobe.
D.
Mediastinal shift to the right.
The Correct Answer and Explanation is:
Answer: D. Mediastinal shift to the right.
Explanation:
A thoracentesis is a procedure to remove excess fluid from the pleural space around the lungs to relieve symptoms and aid in diagnosis. After the procedure, careful monitoring is crucial to identify potential complications. The key findings from this procedure include changes in breath sounds, drainage characteristics, and shifts in mediastinal structures.
Assessment Findings:
- Dullness bilaterally on percussion: Dullness on percussion may indicate fluid accumulation or lung consolidation but is not typically an immediate post-thoracentesis emergency finding. It could be due to other underlying conditions and may require further evaluation but isn’t immediately critical.
- Serosanguinous drainage from the chest tube: Serosanguinous drainage is a mixture of serum and blood and is commonly observed after a thoracentesis. It usually indicates minor bleeding or irritation but does not necessarily signify an immediate complication. The amount and nature of drainage should be monitored, but serosanguinous fluid itself is not an urgent concern.
- Diminished breath sounds in the left lower lobe: Diminished breath sounds in the area where fluid was removed can be a normal finding post-procedure. This may occur due to residual effects of fluid removal or temporary lung collapse (atelectasis) but should be monitored closely.
- Mediastinal shift to the right: This finding is a critical concern and indicates a significant change in the position of the mediastinum, which is the central part of the chest cavity between the lungs. A mediastinal shift to the right can suggest a large pleural effusion or tension pneumothorax on the left side, which can cause the mediastinum to shift towards the opposite side. This can lead to severe respiratory and cardiovascular complications. It often requires immediate intervention to address the underlying issue and stabilize the patient.
In summary, while all the findings should be assessed, a mediastinal shift to the right is the most concerning and requires immediate reporting to the healthcare provider. This could signal a critical shift in the chest cavity that could impact cardiac and respiratory function, necessitating prompt evaluation and intervention.